Assessing Performance in Health Care Using International Surveys: Are Patient and Clinician Perspectives Complementary or Substitutive.

BACKGROUND: Over the last decade, international surveys of patients and clinicians have been used to compare health care across countries. Findings from these surveys have been extensively used to create aggregate scores and rankings. OBJECTIVE: To assess the concordance of survey responses provided by patients and clinicians. METHODS: Analysis of 16 pairs of questions that focused on coordination, organizational factors, and patient-centered competencies from the Commonwealth Fund International Health Policy Survey of older adults (2014) and of primary care physicians (2015). Concordance was assessed by comparing absolute rates and relative rankings. RESULTS: In absolute terms, patients and clinicians gave differing responses for questions about coordination of care (patients were more positive) and provision of after-hours care (patients were less positive). In relative terms, country rankings were positively correlated for 5 of 16 question pairs (Spearman ρ > .6 and P < .05). CONCLUSION: Patterns of concordance between patient and clinician perspectives provides information to guide the use of survey data in performance assessment. However, this study highlights the need to assess the complementarity and substitutive nature of patients' and clinicians' perspectives before combining them to create aggregate assessments of performance.

Earthquakes to Floods: A Scoping Review of Health-related Disaster Research in Low- and Middle-income Countries.

INTRODUCTION: Health-related disaster research is a relatively small; but growing field of inquiry.  A better understanding of the scope and scale of health-related disaster research that has occurred in low- and middle-income countries (LMICs) would be useful to funders, researchers, humanitarian aid organizations, and governments as they strive to identify gaps, disparities, trends, and needs of populations affected by disasters. METHODOLOGY: We performed a scoping review using the process outlined by Arksey & O'Malley to assess the characteristics of peer-reviewed publications of empirical health-related disaster research conducted in LMICs and published in the years 2003-2012. RESULTS: Five hundred and eighty-two relevant publications were identified.  Earthquakes were by far the most commonly researched events (62% of articles) in the review's timeframe.  More articles were published about disasters in China & South Asia/South East Asia than all other regions.  Just over half of the articles (51%) were published by research teams in which all the authors' primary listed affiliations were with an institution located in the same country where the research was conducted.  Most of the articles were classified as either mental health, neurology and stress physiology (35%) or as traumatology, wounds and surgery (19%).  In just over half of the articles (54%), data collection was initiated within 3 months of the disaster, and in 13% research was initiated between 3 and 6 months following the disaster.  The articles in our review were published in 282 different journals. DISCUSSION: The high number of publications studying consequences of an earthquake may not be surprising, given that earthquakes are devastating sudden onset events in LMICs.  Researchers study topics that require immediate attention following a disaster, such as trauma surgery, as well as health problems that manifest later, such as post-traumatic stress disorder.  One neglected area of study during the review's timeframe was the impact of disasters on non-communicable and chronic diseases (excluding mental health), and the management of these conditions in the aftermath of disasters. Strengthening disaster research capacity is critical for fostering robust research in the aftermath of disasters, a particular need in LMICs.

Direct effects of RFRP-1, a mammalian GnIH ortholog, on ovarian activities of the cyclic mouse.

Arg(R)-Phe(F)-amide related peptide-1 (RFRP-1) and -3 (RFRP-3) are known as mammalian orthologs of gonadotropin-inhibitory hormone (GnIH). In mammals, these RFRPs are expressed not only in the hypothalamus and but also in gonads. Inhibitory roles of the hypothalamic and gonadal RFRP-3 in reproduction have been documented in mammals. However, functional roles of the hypothalamic and gonadal RFRP-1 in reproduction are still unclear in mammals. Therefore, in vitro studies were conducted to elucidate the direct effect of RFRP-1, a mammalian GnIH ortholog, on ovarian activities, such as steroidogenesis, apoptosis, cell proliferation and metabolism in the cyclic mouse. The ovaries collected from the proestrus mice were cultured in vitro with different doses (Control, 1ng/ml, 10ng/ml and 100ng/ml) of RFRP-1 for 24h at 37°C. A significant dose-dependent increase in estradiol release from the ovary was detected after the treatment of RFRP-1. Therefore, changes in the ovarian activities, such as steroidogenic markers (luteinizing hormone receptors; LH-R and 3ß-hydroxysteroid dehydrogenase; 3ß-HSD), apoptotic markers [Poly(ADP-ribose) polymerase-1; PARP-1 and cysteine-aspartic protease; caspase-3], a cell proliferation marker (proliferating cell nuclear antigen; PCNA) and metabolic markers (GLUT-4; glucose uptake) were assessed by the treatment of RFRP-1 in the proestrus ovary. The densitometry analysis showed the treatment of RFRP-1 significantly increased the expressions of LH-R and 3ß-HSD, steroidogenic markers. In contrast, the expressions of PCNA, a cell proliferation maker; PARP-1 and caspase-3, apoptotic markers were significantly decreased. Interestingly, RFRP-1 treatment further increases significantly glucose uptake and GLUT-4 receptor expression. These findings indicate that RFRP-1 possesses a stimulatory effect on ovarian steroidogenesis in the proestrus mouse. This is the first evidence showing the direct action of RFRP-1 on steroidogenesis in any vertebrate. In addition, RFRP-1 may also act directly on ovarian folliculogenesis as an inhibitory factor.

Ethics of emergent information and communication technology applications in humanitarian medical assistance.

New applications of information and communication technology (ICT) are shaping the way we understand and provide humanitarian medical assistance in situations of disaster, disease outbreak or conflict. Each new crisis appears to be accompanied by advancements in humanitarian technology, leading to significant improvements in the humanitarian aid sector. However, ICTs raise ethical questions that warrant attention. Focusing on the context of humanitarian medical assistance, we review key domains of ICT innovation. We then discuss ethical challenges and uncertainties associated with the development and application of new ICTs in humanitarian medical assistance, including avoiding harm, ensuring privacy and security, responding to inequalities, demonstrating respect, protecting relationships, and addressing expectations. In doing so, we emphasize the centrality of ethics in humanitarian ICT design, application and evaluation.